Rising Alkaline Phosphatase While on Doublet Therapy for M1a Hormone Sensitive Prostate Cancer

[103532]

Hello friends,

I am having a hard time sleeping due to a nagging suspicion. My husband has very high risk, hormone sensitive M1a pc which has been kept undetectable since January, ‘24 with doublet (Elgard/Abi/Pred and IMRT. His ALP baseline was 62 at initial dx in 4/22 and rose to 88 when he had a clinical recurrence in November, '23. Since April, '24 , his alkaline phosphatase has been in the 60’s again at 3-month measurements, but at our last week’s oncology visit, I noted a rise to 92. (the highest yet). Meanwhile, his PSA remained undetectable. Could something be cooking since the prev. rise was associated with lymph mets? He is a bit more tired. He also had high neutrophils and low lymphocytes during this metabolic panel. The doctor is not concerned, but I am very worried. Have any of you experienced this, or have any thoughts on the issue? His oncologist feels waiting for another 3 month test is fine. Thanks for any and all advice you can give me.🤞🙏❤️

[FlyJ]

"The normal range for alkaline phosphatase (ALP) levels can vary depending on the lab and other factors, but is usually between 44 and 147 international units per liter (IU/L). Some organizations recommend a range of 30 to 120 IU/L."

I understand why you might feel concern the slight rise in his ALP. But It seems VERY VERY unlikely that he would have bone mets causing a rise in his ALP with a undetectable PSA.

You should sleep well and get the f/u tests in 3 mos.

[103532 in reply to FlyJ]

Thank you for your opinion on this. I appreciate it!

[Soumen79]

You should not worry a single bit.

[103532 in reply to Soumen79]

Thank you!

[God_Loves_Me]

Rising ALP and declining PSA - Liver stressed

[GP24]

The standard range for ALP is 40 to 130 U/l. Therefore no reason to worry. The ADT often causes fatigue, therefore he is tired. Exercise should help.

[Justfor_]

I will difer with the posts you have already received. Of course, this shouldn't upset your sleep but it is well prudent to be watchful of ALP. From my personal case, check my bio, I have noticed that there is noticeable regression of ALP with PSADT (NOT PSA!). The explanation I give to the latter is that I have ALP counts every 3 months vs monthly PSAs. Additionally, the time constants of the two may difer by large. One mistake that you do, as probably everyone else, is that you think that "undetectable" bears any quantitative weight. It is an "invention" of lazy docs that practice it to keep the patient happy and at the same time to censor questions they can't answer (ex: Why doc my PSA has tripled from 0.005 to 0.015 within one month?). Bottom line: Your latest undetectable can be 10x the preceding one, hence, the increase in ALP bears some useful information.

[103532 in reply to Justfor_]

Thank you. I am watching this very closely!

[Purple-Bike in reply to 103532]

My ALP recently rose more than that, to 30% above the high mark of the reference range, and a couple of weeks later rising slightly higher. PSA stayed at undetectable, LDH did not rise and ALT/AST stayed the same. Now, three weeks later, ALP dropped to the old level just below that high mark where it had been steady in a small range for 3.5 years ever since radiation to a met.

Being low PSA with 1.7 at dx four years ago, I pay particular attention to my ALP. Upset, I took a large dose of a substance that has fervent advocates but with low level of evidence, after which the ALP went down. I assume the likelihood of that being the cause of the drop in ALP is small, but I can´t take the chance so I guess I`m stuck with it (IP6 + Inositol).

The only reason I can find for a transient bump in ALP without bone or liver issues is "Benign Transient Hyperphosphatasia, (BTH), usually caused by a transient decreased clearance of ALP. However, what I can see of this are temporary much larger ALP increases than I had.

[103532 in reply to Purple-Bike]

Thank you for that explanation. I am hesitant to have him wait until the end of November for his next labs, and may see if we can do them at the end of October instead. I am glad your results are trending back down in the correct direction. I will keep you all posted as to what the next labs show.